Clinical Studies on Priligy and Viagra Combination

Across all 5 RCTs, syncope (including loss of consciousness) occurred in 0.05% of men in the placebo groups, 0.06% of men in the dapoxetine 30 mg groups and 0.23% of men in the dapoxetine 60 mg groups (no statistical analysis presented). Orthostatic hypotension has been reported in clinical trials, and the summary of product characteristics includes recommendations to minimise this risk. This states that before treatment initiation, a careful medical examination including history of orthostatic events should be performed by the clinician.

Medication	Active Ingredient	Dosage Forms	Onset Time	Duration of Action
Priligy	Dapoxetine	Tablets (30mg/60mg)	1-3 hours	4-6 hours
Viagra	Sildenafil	Tablets (50mg/100mg)	30-60 mins	4-6 hours
Cialis	Tadalafil	Tablets (10mg/20mg)	30 mins	Up to 36 hours
Levitra	Vardenafil	Tablets (10mg)	25-60 mins	About 4-5 hours

An orthostatic test should be performed before initiating therapy (blood pressure and pulse rate, supine and standing).

• Priligy should be avoided with SSRIs due to serotonin syndrome risk.
• Viagra should not be taken with nitrate medications.
• Always inform your doctor about other medications.

The man should be counselled on the risk of prodromal symptoms such as light-headedness soon after standing and the risk of syncope.

Condition or Drug	Priligy (Dapoxetine)	Viagra (Sildenafil)
Use with MAO inhibitors	Not recommended	Not recommended
Severe cardiac conditions	Caution	Caution
Concurrent nitrates	Contraindicated	Contraindicated
Liver or kidney impairment	Use with caution	Use with caution
History of syncope	Caution	Caution

Treatment with dapoxetine should not be initiated with the 60 mg dose, and if a man has an orthostatic reaction on the 30 mg dose, the dose should not be increased to 60 mg. A 12-week open-label, prospective observational study (Mirone et al.

Full evidence summary

The CHMP concluded that based on IELT data as well as patient- and partner-reported outcome measures, at least 12% more men respond to dapoxetine 30 mg compared with placebo and an additional 5–10% more men respond to the 60 mg dose compared with the 30 mg dose. The CHMP also recommended that additional changes were to be made to the summary of product characteristics to further optimise the benefit-risk ratio (see Safety and tolerability section). In the pooled analysis (McMahon et al. 2011), adverse events occurred in 35.1% cialis or viagra for women of men in the placebo groups, 47.0% in the dapoxetine 30 mg 'on demand' groups and 60.3% in the dapoxetine 60 mg 'on demand' groups. Across the groups approximately 3% of men reported severe adverse events and 1% or less of men reported serious adverse events. 2014) assessed the safety profile of dapoxetine compared with 'alternative care'. A total of 9443 men (mean age 40 years) were assessed: 6128 were treated with dapoxetine 30 mg or 60 mg 'on demand' and 3315 were treated with 'alternative care'.

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In the alternative care group, men were treated in a variety of ways including oral treatment with longer-acting SSRIs such as paroxetine or sertraline, topical treatment or behavioural counselling.

• Common Priligy side effects include nausea and dizziness.
• Viagra may cause headaches and visual disturbances.
• Serious risks include priapism and allergic reactions.

Treatment-emergent adverse events were reported by 12.0% of the dapoxetine group compared with 8.9% of the alternative care group. The most common treatment-emergent adverse events were nausea, headache and vertigo, with a higher incidence in the dapoxetine group (3.1%, 2.6% and 1.0% respectively) than in men who were taking oral treatment in the alternative care group (2.3%, 1.3% and 0.9% respectively).

Side Effect	Priligy (Dapoxetine)	Viagra (Sildenafil)
Headache	Yes	Yes
Dizziness	Yes	Yes
Flushing	Rare	Common
Nasal Congestion	Rare	Rare
Gastrointestinal upset	Possible	Possible

Men in the dapoxetine group had an orthostatic test at baseline: 70 men had an orthostatic reaction and 60 of these men took dapoxetine and were included in the safety analysis.

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In addition, the majority of men in the dapoxetine groups (69.3% in the 30 mg group and 61.7% in the 60 mg group) did not report that their PE was 'better' or 'much better'. (2011) also presented pooled analyses from 2 of the included studies (Buvat et al. 2010) for the percentage of men reporting 'quite a bit' or 'extreme' ejaculation-related personal distress or ejaculation-related interpersonal difficulty. For both of these outcomes there were statistically significant reductions with dapoxetine 30 mg and 60 mg compared with placebo at 12 weeks. For the percentage of men reporting 'quite a bit' or 'extreme' ejaculation-related personal distress, there was a reduction from 73.5% (545/742) to 39.0% (268/688) with placebo, from 71.3% (529/742) to 28.2% (194/689) with dapoxetine 30 mg and from 69.7% (519/745) to 22.2% (153/690) with dapoxetine 60 mg (p<0.001 for comparisons with placebo).

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For the percentage of men reporting 'quite a bit' or 'extreme' ejaculation-related interpersonal difficulty, there was a reduction from 38.5% (286/742) to 23.8% (164/688) with placebo, from 38.8% (288/742) to 16.0% (110/689) with dapoxetine 30 mg and from 36.1% (269/745) to 12.3% (85/690) with dapoxetine 60 mg (p<0.001 for comparisons with placebo). As part of the process of granting a UK marketing authorisation for dapoxetine, the European Medicines Agency's Committee for Medicinal Products for Human Use (CHMP) considered evidence on the benefit/risk balance of the 60 mg dose. Concerns had been raised that the benefit of 60 mg compared with 30 mg was considered too modest to outweigh the potentially increased risk for severe events of syncope. The CHMP concluded that a statistically significant efficacy difference in favour of 60 mg compared with 30 mg had been established. However, the mean (or median) difference in IELT between the 30 mg and 60 mg dose appears marginal. No syncope events were reported in any of the men treated with dapoxetine during the study.

Additional information

Population: the pooled analysis included 6081 men aged 18 years and over (mean age 41; 71% white) who had been in a monogamous heterosexual relationship for at least 6 months and who met DSM-IV-TR criteria for premature ejaculation. In 4 of the studies, participants also had to have an IELT of 2 minutes or less in at least 75% of 4 or more sexual intercourse events at baseline. Participants in the studies reported having premature ejaculation for an average of 15 years, with 65% of participants considered to have lifelong premature ejaculation by the study investigators. In those participants in whom it was recorded (n=4832), average IELT at baseline was 0.9 minutes. Intervention and comparison: in 4 studies (Pryor et al.

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2006 [2 studies reported], Buvat et al. 2010) (n=4843), participants were randomised 1:1:1 to placebo, dapoxetine 30 mg or dapoxetine 60 mg to be taken 'on demand' (1 to 3 hours before anticipated sexual intercourse). (2009) (n=1238), participants were randomised 2:2:1 to dapoxetine 60 mg once daily, dapoxetine 60 mg 'as needed' and placebo. 2010) evaluated IELT as the primary outcome, defined as the duration of time from penetration to intravaginal ejaculation and measured by a stopwatch held by the female partner during each episode of intercourse. Secondary outcome measures in these 4 studies included patient-reported outcomes such as the clinical global impression of change in premature ejaculation (where participants were asked to rate their premature ejaculation as 'much worse', 'worse', 'slightly worse', 'no change', 'slightly better', 'better' or 'much better') and items from the Premature Ejaculation Profile (PEP), a validated tool that includes measures of perceived control over ejaculation.

Further reading and references

Missing post-baseline data were substituted with the last post-baseline observation carried forward. Three of the included studies (Pryor et al. 2009) stated that participants were expected to attempt sexual intercourse 6 or more times each month during the study period. Safety outcomes included pooled data from all 5 studies for adverse events and safety observations of well-recognised selective serotonin reuptake inhibitor (SSRI)-related effects concerning mood, akathisia, anxiety, suicidality or SSRI discontinuation syndrome reported separately from each study. Table 1 Summary of pooled analysis McMahon et al. However, the observational design of this study limits the conclusions that can be drawn.

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The pooled analysis of results from 4 phase III studies showed that there was an increase from baseline in mean IELT at 12 weeks with all 3 groups, including the placebo group. There was a statistically significantly greater increase from baseline in mean IELT at 12 weeks with both dapoxetine 30 mg and 60 mg 'on demand' compared with placebo 'on demand' (from 0.9 minutes in all groups to 1.9, 3.1 and 3.6 minutes respectively for placebo, dapoxetine 30 mg and dapoxetine 60 mg; p<0.001 for comparisons with placebo). The RCTs that contributed to the pooled analysis also individually showed statistically significantly greater increases of similar magnitude in mean IELT at 12 weeks with both strengths of dapoxetine compared with placebo (p<0.001). One of the included studies (Buvat et al. 2009) was continued for 24 weeks and the statistically significant increase in mean IELT with dapoxetine 30 mg and 60 mg 'on demand' compared with placebo 'on demand' was still maintained at this time point (p<0.001).

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(2011) also presented exploratory analyses of geometric means (a measure of central tendency) for the 12-week IELT. Because IELT may be influenced by several factors and it is not expected to be normally distributed, it has been previously suggested that geometric mean may be preferred over average mean to correct for this skewed distribution. The increase from baseline in geometric viagra pfizer mean values for IELT was also statistically significantly greater for dapoxetine 30 mg and 60 mg 'on demand' compared with placebo 'on demand' (p<0.001). Whilst there is no generally agreed minimum clinically important change in IELT, Pryor et al. (2006) concluded that it was about 1 minute, based on a correlation of global impression of change scores with mean changes in IELT.

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In the pooled analysis, the improvement in mean 12-week IELT from baseline for the placebo group was 1 minute. In the pooled analysis, the difference between placebo and dapoxetine 30 mg for the improvement in mean 12-week IELT was 1.2 minutes. In both the pooled analysis and the individual studies, the difference between dapoxetine 30 mg and 60 mg 'on demand' for the mean IELT at 12 weeks was less than 1 minute (0.5 minutes for the pooled analysis; no statistical analysis reported). The percentage of men who reported that their premature ejaculation was 'better' or 'much better', and who reported 'good' or 'very good' satisfaction with sexual intercourse and 'good' or 'very good' perceived control over ejaculation was statistically significantly higher with dapoxetine 30 mg and 60 mg 'on demand' compared with placebo 'on demand' (all p<0.001, see table 1 for details). However, the differences between the 30 mg and 60 mg strengths were small (no statistical analysis reported).